When we talk about nutrition during pregnancy, certain nutrients immediately spring to mind. Folic acid is essential for early neural development, iron supports the expanding blood supply, and iodine plays a critical role in thyroid function and brain development.

But there's another nutrient that receives considerably less attention, despite playing some fascinating roles in the development of the nervous system.

It's called choline, and new research suggests it may have a more significant influence on early childhood development than many people realise.

A randomised controlled trial published in the American Journal of Obstetrics & Gynecology has reported some intriguing findings linking maternal choline supplementation with differences in children's cognitive performance and social development.

What Did the Researchers Discover?

Researchers recruited 206 pregnant women and randomly assigned them to receive either a phosphatidylcholine supplement or a placebo, beginning at approximately 16 weeks of pregnancy and continuing until delivery.

Phosphatidylcholine is a compound containing choline, a nutrient naturally present in foods including eggs, meat, fish and certain plant foods.

The supplementation protocol was substantial: participants received 9,000mg of phosphatidylcholine daily. Importantly, that figure refers to the weight of phosphatidylcholine, not 9,000mg of choline itself.

The researchers subsequently assessed the children's development, examining aspects of behaviour, language and cognitive performance during their first four years of life.

The findings were particularly interesting.

At four years of age, children whose mothers had received phosphatidylcholine scored, on average, nearly eight points higher on standardised cognitive assessments than children in the placebo group.

The researchers also reported differences in social behaviour. Among children whose parents completed the relevant assessments, approximately 4% in the supplemented group showed elevated social withdrawal problems, compared with 24% in the placebo group.

These findings suggest that maternal choline availability during pregnancy may influence aspects of early brain development.

However, there are important limitations. Approximately one-third of participants did not complete the four-year follow-up, and some behavioural outcomes relied on parental reporting. These factors mean the results require confirmation in larger trials.

Why Is Choline Important for Brain Development?

Choline is involved in several fundamental biological processes, many of which become particularly important during pregnancy.

One of its major functions is supporting the production of phospholipids, including phosphatidylcholine, which form essential structural components of cell membranes.

Every cell in the body relies on these membranes, but they're particularly important during periods of rapid growth and development.

During pregnancy, the developing brain is producing enormous numbers of new cells and establishing increasingly complex connections between them. Adequate supplies of the nutrients involved in building and maintaining cellular structures are therefore essential.

Choline is also required to produce acetylcholine, a neurotransmitter involved in communication between nerve cells. Acetylcholine has important roles in attention, learning, memory and several other neurological functions.

And there's another interesting dimension to choline's biology.

Choline and the Chemistry of Gene Regulation

Choline also contributes to a process known as methylation.

Methylation involves the transfer of small chemical groups between molecules and is essential for numerous biochemical reactions, including those involved in regulating gene activity.

Some of choline's metabolic products help supply methyl groups through pathways that interact with folate and vitamin B12 metabolism.

These processes are especially interesting during pregnancy because the developing foetus is undergoing rapid cellular differentiation, with different cells becoming specialised to perform particular functions.

Methylation is one of several mechanisms involved in regulating how genes are expressed during development.

This doesn't mean that eating more choline simply switches desirable genes on or off. The biology is far more complicated than that.

But it helps explain why researchers are interested in choline as something more than just another component of a healthy diet.

Where Do We Get Choline From?

Choline is found in a variety of foods, although the amounts vary considerably.

Egg yolks are among the better-known dietary sources, alongside meat, fish and dairy products. Plant foods such as soybeans, beans, broccoli and certain wholegrains also contribute to choline intake.

For people eating a varied omnivorous diet, these foods can collectively provide meaningful amounts of choline.

Those following predominantly plant-based diets can also obtain choline, although it may require more deliberate attention to food choices.

During pregnancy, nutritional requirements change to support both maternal physiology and foetal development. Choline is particularly relevant because it contributes to the growth and development of new tissues.

However, it's important to distinguish between obtaining adequate choline through food and using high-dose supplementation.

The new trial investigated a specific phosphatidylcholine supplement at a particular dose. It did not establish that eating more eggs, for example, would produce the same developmental effects.

Does This Mean Pregnant Women Should Take Choline Supplements?

Not automatically.

Although the results are encouraging, this is one trial, and the substantial loss to follow-up makes it important to interpret the findings cautiously.

Other studies have produced different results. For example, an earlier randomised controlled trial investigating phosphatidylcholine supplementation during pregnancy found no significant improvements in several measures of infant cognitive development.

Differences in supplement dose, timing, study populations and the ages at which children were assessed may help explain some of these discrepancies.

We also cannot assume that a larger dose is necessarily better.

Pregnancy is a period when supplement decisions deserve particular care, and the dose used in this trial should not be treated as a recommendation for routine use.

Anyone who is pregnant or planning a pregnancy should discuss their individual nutritional needs and any supplements with an appropriately qualified healthcare professional.

A Fascinating New Direction for Pregnancy Nutrition

What I find particularly interesting about this research is how it highlights the complexity of nutrition during early development.

We often think about pregnancy nutrition primarily in terms of preventing deficiencies and supporting healthy foetal growth.

But researchers are increasingly investigating whether the availability of particular nutrients during specific developmental periods might influence how the nervous system develops and functions years later.

Choline is especially interesting because it sits at the intersection of several important processes: cell membrane formation, neurotransmitter production and methylation.

This new trial adds to the evidence that maternal choline nutrition deserves serious scientific attention, although it doesn't yet justify widespread high-dose supplementation.

For now, the most sensible message is to recognise choline as an important part of good pregnancy nutrition, alongside the many other nutrients required for healthy development.

Because supporting a developing brain isn't about finding one miracle nutrient. It's about providing the complex nutritional foundations on which that brain is built.

References

Hunter, S.K. et al. (2026) ‘Prenatal maternal phosphatidylcholine and children's behavior and cognition through 4 years of age: Randomized clinical trial’, American Journal of Obstetrics & Gynecology. https://doi.org/10.1016/j.ajog.2026.10.017

Cheatham, C.L., Goldman, B.D., Fischer, L.M., da Costa, K.-A., Reznick, J.S. and Zeisel, S.H. (2012) ‘Phosphatidylcholine supplementation in pregnant women consuming moderate-choline diets does not enhance infant cognitive function: a randomized, double-blind, placebo-controlled trial’, The American Journal of Clinical Nutrition, 96(6), pp. 1465–1472. https://doi.org/10.3945/ajcn.112.037184

Hunter, S.K., Hoffman, M.C., D'Alessandro, A. and Freedman, R. (2024) ‘Developmental windows for effects of choline and folate on excitatory and inhibitory neurotransmission during human gestation’, Developmental Psychobiology, 66(2), e22453. https://doi.org/10.1002/dev.22453